The Effect of Mindfulness and Acupuncture on Psychological Health in Veterans: an Exploratory Study
iRest Yoga Nidra® is a guided mindfulness approach that encourages relaxation, focused attention, experience of joy, observation of opposite feelings and emotions, non-judgment, and integration of these principles into daily life. iRest was developed for the military population, but the research on its effectiveness is in its infancy. This exploratory study examined the effectiveness of iRest in combination with acupuncture compared to acupuncture alone in improving psychological health in Veterans. The combined treatment yielded significant psychological benefit in depression, psychological symptom severity, depression or tension due to pain, and emotional interference with life activities, while the acupuncture-only treatment did not. Although both conditions showed significant decreases in perceived stress, the effect size for the treatment group was medium to large compared to a small effect size for those receiving acupuncture only. The combined treatment condition, iRest plus acupuncture, also demonstrated clinically meaningful change, with significant decreases in the number of Veterans meeting criteria for mild, moderate, and severe depression. Finally, the combined treatment was equally beneficial independent of factors such as age, gender, or race. Given the pervasiveness of psychological distress and depression in the Veteran population and the efficiency with which these group treatments can be provided, these findings lend preliminary support for the extension of complementary and integrative health offerings including iRest and acupuncture into more Veterans Administration hospitals across the country to improve military mental health. Indeed, the encouraging results of this exploratory study underscore the importance of expanded research on iRest and acupuncture for the treatment of psychological health.
KeywordsMindfulness Acupuncture Alternative medicine Complementary medicine Integrative medicine Depression
MSW: designed and executed the research, assisted with the data analyses, and wrote the manuscript. CRG, DBA, and AH: collaborated with the design of the study and editing of the manuscript. PS: collaborated with the design of the study and analyzed the data.
No funding sources declared for this study.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent and IRB Approval
Informed consent was obtained from all individual participants included in the study. Full internal review board (IRB) approval was obtained from the Washington, DC Veterans Affairs Medical Center IRB (#01503), where data collection and analysis were conducted. The Catholic University of America’s IRB also reviewed and approved the study.
- Asher, G. N., Jonas, D. E., Coeytaux, R. R., Reilly, A. C., Loh, Y. L., Motsinger-Reif, A. A., & Winham, S. J. (2010). Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine, 16, 1097–1108. https://doi.org/10.1089/acm.2009.0451.CrossRefPubMedPubMedCentralGoogle Scholar
- Beck, A. T., Steer, R. A., & Brown, G. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
- Bedard, M., Felteau, M., Gibbons, C., Klein, R., Mazmanian, D., Fedyk, K., & Mack, G. (2005). A mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries: one-year follow-up. Journal of Cognitive Rehabilitation, 23, 8–13. https://doi.org/10.1080/0963828031000090489.Google Scholar
- Bhogaonker, P. (2012). Impact of brief meditation training on stress, distress, and quality of life for homeless adults (Doctoral dissertation). Retrieved from ProQuest Dissertations. (3544996).Google Scholar
- Bingham, M. O., Peacock, W. P., Fritts, M. J., & Walter, J. A. G. (2014). Effects of integrative restoration on sleep, perceived stress and resilience in military medical center healthcare providers: a pilot study. Retrieved January 20, 2014, from http://www.irest.us/sites/default/files/CCF_Poster_BAMC_Study.pdf
- Birdsall, B., Pritchard, M., Elison-Bowers, P., & Spann, J. (2011). Does integrative restoration (iRest) meditation decrease perceived stress levels and negative moods in school counselors? Retrieved January 20, 2014, from http://counselingoutfitters.com/vistas/vistas11/Article_84.pdf
- Borchardt, A. R., Patterson, S. M., & Seng, E. K. (2014). The effect of meditation on cortisol: a comparison of meditation techniques to a control group. Retrieved January 20, 2014, from http://www.irest.us/sites/default/files/Meditation%20on%20Cortisol%2012.pdf
- Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health: Claremont symposium on applied social psychology (pp. 31–67). Newbury Park, CA: Sage.Google Scholar
- Engel, C. E. J., Choate, C. G., Cockfield, D., Armstrong, D. W., Jonas, W., Walter, J. A. G., ... Miller, R. (2006). Yoga nidra as an adjunctive therapy for post-traumatic stress disorder: a feasibility study. Retrieved January 20, 2014, from http://www.irest.us/sites/default/files/WRAMH_PTSD_YN_Results_0.pdf
- Goyal, M., Sing, S., Sibinga, E. M. S., Gould, N. F., Rowland-Seymour, A., Sharma, R., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. Journal of American Medical Association: Internal Medicine, 174, 357–368. https://doi.org/10.1001/jamainternmed.2013.13018.Google Scholar
- Grant, S., Hempel, S., Kandrack, R., Motala, A., Shanman, R. M., Booth, M., et al. (2015). Needle acupuncture for substance use disorder. Santa Monica, CA: Rand Corporation.Google Scholar
- Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A., & Kesper, U. (2007). Mindfulness training as an intervention for fibromyalgia: evidence of post-intervention and 3-year posttest benefits in well-being. Psychotherapy and Psychosomatics, 76, 226–233. https://doi.org/10.1159/000101501.CrossRefPubMedGoogle Scholar
- Healthcare Analytics and Information Group. (2015). FY 2–15 VHA Complementary & Integrative Health (CIH) Services (Formerly CAM). Retrieved September 23, 2016, from http://www.scienceblogs.com/insolence/files/.../FY2015_VHA_CIH_signedReport.pdf
- Hemple, S., Taylor, S. L., Solloway, M., Miake-Lye, I. M., Beroes, J. M., Shanman, R., … Shekelle, P.G. (2014). Evidence map of acupuncture VA-ESP Project #05–226. Retrieved February 1, 2015, from http://www.hsrd.research.va.gov/publications/esp/acupuncture.pdf
- Hull, A., Brooks Holliday, S., Eickhoff, C., Sullivan, P., Reinhard, M., Sossin, K., & Courtney, L. (2015, August). Integrative Health and Wellness (IHW) Program: mental and physical health outcomes associated with program enrollment in a veteran sample. Paper presented at the annual meeting of the American Psychological Association, Toronto, Canada.Google Scholar
- Hull, A., Reinhard, M., McCarron, K., Allen, N., Jecmen, M., Akhter, J., et al. (2014). Acupuncture and meditation for military veterans: first steps of quality management and future program development. Global Advances in Health and Medicine, 3(4), 27–31. https://doi.org/10.7453/gahmj.2013.050.CrossRefPubMedPubMedCentralGoogle Scholar
- Integrative Restoration Institute (2014). iRest yoga nidra research and programs: current, upcoming and planned iRest yoga nidra research. Retrieved January 20, 2014, from http://www.irest.us/programs/irest-research-and-programs
- Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33–47. https://doi.org/10.1016/0163-8343(82)90026-3.CrossRefPubMedGoogle Scholar
- Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Dell.Google Scholar
- Kabat-Zinn, J. (1994). Wherever you go there you are: mindfulness meditation in everyday life. New York: Hyperion.Google Scholar
- Lee, C., Wallerstedt, D., Duncan, A., York, A., Hollifield, M., Niemtzow, R. C., et al. (2011). Design and rationale of a comparative effectiveness study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Medical Acupuncture, 23, 237–247. https://doi.org/10.1089/acu.2011.0836.CrossRefPubMedCentralGoogle Scholar
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
- Miller, R. (2005). Yoga nidra: the meditative heart of yoga. Boulder, CO: Sounds True.Google Scholar
- Miller, R. (2014). Your brain on yoga nidra: questions for Richard Miller. KYTA Bulletin: Kripalu center for yoga and health. Retrieved January 5, 2014, from http://www.kripalu.org/kyta_artcl.php?id=265
- National Institutes of Health (1997). Acupuncture. NIH Consensus Statement. Retrieved May 4, 2016 from https://consensus.nih.gov/1997/1997acupuncture107html.htm
- Nhat Hanh, T. (1976). The miracle of mindfulness: a manual for meditation. Boston, MA: Beacon Press.Google Scholar
- Pence, P., Katz, L. S., Huffman, C., & Cojucar, G. (2014). iRest yoga nidra: a pilot study to treat women Veterans. Retrieved January 20, 2014, from http://www.irest.us/sites/default/files/Long_Beach_VA_MST_Study.pdf
- Perich, T., Manicavasagar, V., Mitchell, P. B., & Ball, J. R. (2013). The association between meditation practice and treatment outcome in mindfulness-based cognitive therapy for bipolar disorder. Behaviour Research and Therapy, 51, 338–343. https://doi.org/10.1016/j.brat.2013.03.006.CrossRefPubMedGoogle Scholar
- Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., et al. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. Journal of the American Medical Association, 314, 456–465. https://doi.org/10.1001/jama.2015.8361.CrossRefPubMedGoogle Scholar
- Robson, T. (2004). An introduction to complementary medicine. New York: Allen & Unwin.Google Scholar
- Saraswati, S. S. (1998). Yoga nidra. New Delhi: Bihar School of Yoga.Google Scholar
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse (2nd ed.). New York: Guilford Press.Google Scholar
- Smeeding, S. J., Bradshaw, D. H., Kumpfer, K., Trevithick, S., & Stoddard, G. J. (2010). Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic pain and stress-related depression, anxiety, and post-traumatic stress disorder. Journal of Alternative and Complementary Medicine, 16, 823–835. https://doi.org/10.1089/acm.2009.0510.CrossRefPubMedGoogle Scholar
- Stankovic, L. (2011). Transforming trauma: a qualitative feasibility study of integrative restoration (iRest) yoga nidra on combat-related post-traumatic stress disorder. International Journal of Yoga Therapy, 21, 23–37.Google Scholar